中国人群布鲁氏菌病流行病学史及临床表现的系统评价和meta分析

目的研究中国人群中布鲁氏菌病(简称布病)的流行病学史、临床表现及误诊情况。方法检索PubMed、EMBASE、MedLine、CNKI、万方数据库和维普数据库,截至2019年2月,收集关于布病流行病学史、临床表现及误诊情况的文献研究,统计分析采用R软件。结果检索文献中最终纳入83篇,共7 885例患者,78.03%患者有羊、牛等动物密切接触史;患者发热症状的发生率为84.58%(95%CI:83.76%~85.37%),关节疼痛为63.87%(95%CI:62.78%~64.95%),肌肉痛为63.45%(95%CI:61.81%~65.07%)。其中成人布病患者中发热症状的发生率为93.53%(95%CI:91.51%~95.19%),多汗为72.00%(95%CI:68.51%~75.30%),关节疼痛为64.82%(95%CI:61.27%~68.26%);儿童布病患者中发热症状的发生率为91.85%(95%CI:89.10%~94.09%),乏力为53.31%(95%CI:47.65%~58.91%),多汗为49.77%(95%CI:44.98%~54.57%);布病患者就诊误诊率非牧区(70.80%)高于牧区(33.70%)。结论通过了解中国人群布病的流行病学史,掌握不同年龄段布病患者临床表现间的差异,可提高布病的诊断水平,减少误诊,并可及早开展治疗。

Systematic review and meta-analysis of epidemiological history and clinical manifestations of human brucellosis in China

Objective To study the epidemiological history, clinical manifestation and misdiagnosis of human brucellosis in China. Methods Databases of PubMed, EMBASE, MedLine, and CNKI (Chinese), Wanfang (Chinese), Vip (Chinese) were searched for studies concerning epidemiological history, clinical manifestation and misdiagnosis of human brucellosis in China and published before February 2019. Meta-analysis was performed by the R software. Results Eighty-three eligible studies were included in this meta-analysis, with a total of 7,885 patients. 78.03% of the patients had close contact with sheep, cattle and other animals. The incidence rates of fever, arthralgia and muscle pain in the patients were 84.58% (95%CI:83.76%-85.37%), 63.87% (95%CI:62.78%-64.95%) and 63.45% (95%CI:61.81%-65.07%), respectively. The incidence rates of fever, sweating and arthralgia in adult patients with brucellosis were 93.53% (95%CI:91.51%-95.19%), 72.00% (95%CI:68.51%-75.30%) and 64.82% (95%CI:61.27%-68.26%), respectively. The incidence rates of fever, fatigue and sweating in children patients with brucellosis were 91.85% (95%CI:89.10%-94.09%), 53.31% (95%CI:47.65%-58.91%) and 49.77% (95%CI:44.98%-54.57%), respectively. The misdiagnosis rate of human brucellosis was higher in non-pastoral areas than in pastoral areas (70.80% vs. 33.70%). Conclusions Through understanding the epidemiological history of human brucellosis in China and the differences in clinical manifestations of brucellosis patients with different ages, we can improve the diagnosis level of human brucellosis, decrease the misdiagnosis, and give intervention treatment in time.